title: Blood pressure and cardiovascular mortality in dialysis patients with left ventricular systolic dysfunction.
abstract: BACKGROUND
  In patients chronically treated with hemodialysis, the prevalence of heart failure is high with a consequently poor prognosis. The role played by blood pressure (BP) on cardiovascular (CV) mortality of these patients has not been clearly defined.
  
  
  METHODS
  In this follow-up study, we investigated the relationship of pre- and postdialysis measurements of BP with CV and all-cause mortality in a cohort of 557 dialysis patients with a left ventricular (LV) ejection fraction <50%.
  
  
  RESULTS
  During the follow-up (mean = 21.6 ± 8.8 months), 179 deaths were recorded. Ninety-eight patients died from CV causes. By the Cox multivariable analysis, we constructed a predictive model of CV mortality including age, duration on dialysis, diabetes, serum albumin, diffusive dialysis technique, predialysis mean arterial pressure (MAP) (hazard ratio (HR) = 0.978; 95% confidence interval (CI) = 0.956-0.999), and postdialysis MAP (HR = 1.035; 95% CI = 1.010-1.061). The relationship with mortality was inverse for predialysis MAP and direct for postdialysis MAP. In a subsequent analysis, we found that pre- and postdialysis systolic BP, but not diastolic BP, were predictive of CV mortality. Predialysis MAP was in a direct relationship with body mass index. Postdialysis MAP had an inverse relationship with weight loss during dialysis session.
  
  
  CONCLUSIONS
  CV mortality in dialysis patients with LV dysfunction is associated with both pre- and postdialysis BP interacting in a complex relationship. Nutritional state and fluid balance and removal are possible clues to this relationship.
authors.affiliation: Ospedale Santa Maria Della Misericordia, Perugia, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Losito
authors.forename: Lucia
authors.initials: L
authors.lastname: Del Vecchio
authors.forename: Goffredo
authors.initials: G
authors.lastname: Del Rosso
authors.forename: Rosella
authors.initials: R
authors.lastname: Malandra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002423:Cause of Death; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: blood pressure; dialysis; ejection fraction; hypertension; mortality.